Articles of interest

You will find three contributions from Rob Robson – two book chapters from the Resilient Health Care Series (Volume 1 and Volume 5) as well as an earlier article, Giving Back the Pen, originally published in Healthcare Quarterly, Volume 11, 2008.

Also provided is a list of books and articles that have been useful in my understanding of the intersection of Resilience, Complexity and Safety.

ECW in Complex Adaptive Systems

This chapter looks at the question of everyday clinical work [ECW] occurring within a complex adaptive system [CAS] such as health care. The focus on ECW provides a useful bridge from Safety I to Safety II and opens a broad panorama of events and experiences that will allow for a better understanding of organisational resilience.

Giving Back the Pen

In recently published book on the ethics of forgiveness after medical error has harmed a patient, After Harm (Belinger 2005), the author shares his comments attributed to Bishop Desmond  Tutu “If you take my pen and say you are sorry and don’t give me back my pen, nothing has happened”.

Some Background References

The following list was prepared originally for distribution to attendees at a half-day workshop for the patient safety officers at the annual meeting of the Childrens’ Hospitals Association of America in Houston, Texas, in September 2019. It includes some of the articles I have found useful in understanding the evolution of safety science in healthcare.

Untangling Conflict in Healthcare

During a recent vacation in Greece a well-respected senior healthcare leader decided to make a side trip to Delphi to seek advice about a problem that had been vexing her for some years. She was hopeful that the oracle at Delphi could provide some guidance.

Legal Privilege Legislation: Consequences for Patient Safety

Increasing awareness of the extent of preventable harm from healthcare has led to efforts to improve patient safety through a variety of efforts, including legislation. Extending legal privilege to quality and safety reviews leads to further harm for many patients, families and healthcare providers. 

Applying SNAP! to Healthcare

SNAP! promotes an understanding of nonlinearity, not only with respect to the concept of causation of accidents but also to the way in which the involved parties (patients, families, healthcare providers) are engaged in the analytic process; how the chronology of events is constructed; the way in which recommendations are developed; and even the way in which the course is presented.